Syphilis in infants and young children.

Syphilis is a disease very much on the rise in certain populations in this country. It has reached epidemic proportions in some areas. This trend should be a concern to physicians caring for children in the United States. Rates of congenital syphilis are continuing to rise. Certainly, the poor prenatal care received by many women is inhibiting our ability to prevent congenital syphilis. All infants should have a maternal test for syphilis clearly documented before hospital discharge. In the event that maternal history of length of disease or treatment cannot be documented, the infant should be treated with a full course of antibiotics. In addition, all symptomatic infants should be treated and followed to ascertain falling antibody titers. Acquired syphilis should be suspected in any child with either a positive test for syphilis or symptomatic syphilis in whom evidence for congenital syphilis cannot be documented. Sexual abuse must be strongly suspected even in the absence of disclosure, and the case must be reported to local child protective services. Adequate treatment and follow-up must be assured. Clinicians should refamiliarize themselves with the many and varied presentations of syphilis. Many practitioners will be faced with diagnostic and treatment decisions while the infants are still in the newborn nursery. Occasionally, a child will escape diagnosis and present with symptomatic syphilis later. This disease should not be overlooked in the differential diagnoses of many seemingly simple childhood complaints.